Dance Moves

Registration Form

(Please use a separate form for each student)

 

Student’s Name                                                                   Home Phone

Address                                                                            Cell Phone

­­­­­­­­­­­­­­­­­­­­­City                                                                        Zip Code

Mother’s First and Last (if different from the Student’s) Names     Work Phone

Father’s First and Last (if different from the Student’s) Names       Work Phone

Date of Birth                                        Age                                    Grade in School

Email address

 

 

 

Does student have any pre-existing medical conditions?  If yes, please explain:

 

Is student on any medications?  ____________________________________________

Periodically, we wish to use individual photos or group photos on our web site or other publications. At times we may wish to identify your child with the photo using just his/her first name. No last names or personal information such as home address or phone numbers will be published (without obtaining prior permission).

I ____DO  ____ DO NOT  give Dance Moves permission to use photos of my child.

 

I understand that Dance Moves and/or its instructors or staff are not liable for injuries sustained or illnesses contracted by the student while attending the school, performances or rehearsals.

Parent or Adult Signature                                                             Date

 

Registration Fee __ Dancewear __ Invoice ___________ Date ________